MSF medical staff provide care to women with complications during pregnancy at the Gondama Referral Center, in Bo.

Why are we there?

Endemic/epidemic disease

Health care exclusion

Ebola Update

February 12, 2015

Since the Ebola outbreak began in March 2014 in Guinea, it has claimed 9,152 lives (as of February 12). The outbreak has spread far beyond Guinea, and is now raging unabated. A total of four countries have been affected: Guinea, Liberia, Nigeria, and Sierra Leone.

Currently, MSF has over 1,900 staff (157 international staff; 1,750 national staff) responding to the Ebola outbreak in Sierra Leone.

The number of admissions to the MSF Ebola treatment centers (ETC) remains low, with Kailahun and Bo having reached zero patients admitted. However, in all districts outreach activities, surveillance, social mobilization, and training remain a priority.

Our Work

Cases of Ebola were first confirmed in the east of Sierra Leone, near the border with Guinea, at the end of May.

Even before the Ebola outbreak, people in Sierra Leone had limited access to medical care and the health system was both under-resourced and overburdened. Doctors Without Borders/Médecins Sans Frontières (MSF) was working in the country at Gondama, near the city of Bo, running an emergency pediatric and maternity hospital as well as a midwifery clinic in response to the devastating levels of maternal and infant mortality in the country.

When the first cases of Ebola were confirmed in Sierra Leone, the Ministry of Health asked MSF to intervene. Teams opened an Ebola management center (EMC) on the outskirts of Kailahun town on June 26, where testing and care was available for those people suspected of having the virus. MSF teams also launched outreach, health promotion, and disease surveillance activities, and trained local health staff. Community health workers were trained to deliver messages about how people could protect themselves from Ebola and what to do if they showed signs or symptoms of the disease. An MSF psychologist provided support to patients and to families who had lost loved ones. As the virus quickly spread across the country, patients arrived by ambulance from locations up to 10 hours away. The EMC had a maximum capacity of 100 beds. In addition, MSF constructed a small maternity unit in October where pregnant Ebola patients could receive specialized care within the high-risk zone.

Bo, Southern Province

In September, MSF opened a second EMC three miles outside Bo, which was more easily accessible from most parts of the country. The center was extended to accommodate 104 beds. MSF teams carried out outreach, health promotion and surveillance activities, trained local health staff, and offered support to the Ministry of Health’s activities.

Also in Bo, MSF launched a third Ebola project focused on offering specific, structured, and targeted training for other organizations to enable them to run EMCs safely. The training sessions took place in MSF facilities or in those of the other NGOs to help them start activities. In total six other organizations were trained.

Freetown

In early December, as health facilities in the country’s capital, Freetown, became overwhelmed, MSF opened an EMC in the centrally located Prince of Wales secondary school. There were 30 individual rooms for suspected Ebola cases and 70 beds. A new design was used which meant that the intensive care ward could be viewed through Plexiglas and patients could therefore be better monitored by staff who did not have to wear protective gear.

MSF started conducting outreach, health promotion, and surveillance activities in nine sub-districts of Freetown to support the government coordination body, National Ebola Response Centre (NERC), in mapping and following up on Ebola contacts. Epidemiologists visited the areas and had daily meetings with staff from the World Health Organization, the Ministry of Health, and the NERC to support the response system and help where possible. Teams also provided training on disinfecting houses.

Magburaka, Northern Province

On December 15, MSF opened a fourth EMC in Magburaka, Tonkolili district, again, with critical complementary activities including outreach, health promotion, surveillance, and training of local health staff. A rapid response team was established in Magburaka to be deployed quickly wherever new cases appeared in the country.

Infection Control Issues, and Antimalarial Distributions

Many Sierra Leonean health staff on the front line of the outbreak were infected as a result of caring for patients, because they lacked the necessary protective gear and knowledge about the transmission of the disease. Up to 10 percent of local health workers are estimated to have died, leaving government health facilities with even fewer staff than before the epidemic and unable to cope.

In October, MSF suspended its obstetric and pediatric projects in Gondama. Due to the strain on resources as a result of responding to the Ebola outbreak, MSF could not guarantee the extremely high quality of medical care needed to treat patients or the protection of its staff from Ebola infection. Meanwhile, women suffering complications in childbirth and people sick with malaria and other diseases were reluctant to seek care at government hospitals for fear of contracting Ebola, and untold numbers of people are thought to have died from non-Ebola-related diseases in 2014. In December, to address the threat of malaria and to avoid confusion with Ebola due the similarity of initial symptoms, MSF recruited and trained some 6,000 volunteers to carry out a four-day, door-to-door distribution of antimalarial treatments in partnership with the Ministry of Health. Some 1.5 million people in the Freetown area were reached. Another distribution campaign was carried out in January 2015.

At the end of 2014, MSF had 959 staff in Sierra Leone. MSF has worked in the country since 1986.

Patient Story

Jenneba, 26 years old

“This is my third pregnancy. I have had two miscarriages before. Last night I felt pain, so an ambulance picked me up from the health center and took me to Gondama. The nurse in the ambulance held my hand and talked to me nicely during the ride.

The nurses at the hospital examined me and said that I wasn’t in labor yet. I am still in pain and very worried about what is happening. If I lose this baby, I am worried that my husband will leave me.”